Credentialing Representative
Company: Highmark Health
Location: Oklahoma City
Posted on: August 5, 2022
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Job Description:
**Company :**Highmark Wholecare**Job Description :**JOB
SUMMARYThis job processes provider applications and re-applications
including initial mailing, review, and loading. Maintains provider
data base and communicates with providers by phone and mail
regarding credentialing status and information. Performs
credentialing, re-credentialing and related activities and
coordinates credentialing verifications. Reviews and processes more
complex additions, updates and deletions of provider information in
the Dental Provider file database. Supports the implementation of
new networks, systems, software, guidelines and other endeavors
with a focus on group practices as opposed to individual providers.
Depending on level, trains credentialing personnel in the use of
various systems, software, databases and procedures. Participates
in projects which streamline, automate or otherwise enhance
credentialing functions.ESSENTIAL RESPONSIBILITIES:+ Credentials
and re-credential providers.+ Contact providers or representatives
by telephone or in writing to obtain additional information while
processing their enrollment applications.+ Screen incoming
applications and paperwork for completeness and accuracy and sends
necessary paperwork to credentialing vendor.+ When necessary
performs credentialing verifications and loads provider to
appropriate networks and credentialing information to the provider
database.+ Manage credentialing inventory, reports and projects to
ensure all established time frames for completing work, reports and
projects are met.+ Depending on level, train credentialing team in
the use of various systems, software, databases, processes and
procedures.+ Create anddistribute monthlyreports as assigned and
handle complex and unusual or high-level credentialing issues.+
Support projects, audits, business partners, internal departments
and external clients.+ Represent department as the Subject Matter
expert.+ Pull and research necessary documentation for audits+
Support updates necessitated by our business partners, internal
departments and external clients.+ Provide customer oversight for
our customers who have unique requirements and timelines to ensure
compliance.+ Depending on level, investigate interim license
actions.+ Participate in projects which streamline, automate, or
otherwise enhance credentialing functions.+ Other duties as
assigned or requested.**QUALIFICATIONS****Minimum**+ High School
Diploma or GED+ 3-5 years of related, progressive experience.
Grandfathered experience requirements effective August 2016.+
Experience in Provider Data Management, Customer Services or
Claims.+ Microsoft office experience (i.e. Word, Excel, PowerPoint,
etc.)**Preferred**+ A familiarity with credentialing processes and
the NCQA standards.+ Experience in the use of OnBase and Cactus
systems.+ Experience with the Customer Service inquiry system or
claims processing concepts.**Knowledge, Skills and Abilities**+
Good written and verbal communication+ Proficient use of Excel for
spreadsheets, and WORD for mail merge letters.+ Proven diplomacy
and a professional demeanor for effective communication with
provider offices, internal personnel, vendors, accounts and
committees.+ Strong written communication and presentation skills
are essential.**SCOPE OF RESPONSIBILITY**Does this role
supervise/manage other employees?No**WORK ENVIRONMENT**Is Travel
Required?No**_Disclaimer:_** _The job description has been designed
to indicate the general nature and essential duties and
responsibilities of work performed by employees within this job
title. It may not contain a comprehensive inventory of all duties,
responsibilities, and qualifications required of employees to do
this job._**_Compliance Requirement:_** _This position adheres to
the ethical and legal standards and behavioral expectations as set
forth in the code of business conduct and company policies_Highmark
Health and its affiliates prohibit discrimination against qualified
individuals based on their status as protected veterans or
individuals with disabilities, and prohibit discrimination against
all individuals based on their race, color, religion, sex, national
origin, sexual orientation/gender identity or any other category
protected by applicable federal, state or local law. Highmark
Health and its affiliates take affirmative action to employ and
advance in employment individuals without regard to race, color,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability.Highmark Health and its
affiliates prohibit discrimination against qualified individuals
based on their status as protected veterans or individuals with
disabilities, and prohibit discrimination against all individuals
based on their race, color, age, religion, sex, national origin,
sexual orientation/gender identity or any other category protected
by applicable federal, state or local law. Highmark Health and its
affiliates take affirmative action to employ and advance in
employment individuals without regard to race, color, age,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability.EEO is The LawEqual
Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
_https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf_
)We endeavor to make this site accessible to any and all users. If
you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.For accommodation requests, please
contact HR Services Online at
HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act
Employees, Contractors, and Applicants NoticeReq ID: J210398
Keywords: Highmark Health, Oklahoma City , Credentialing Representative, Other , Oklahoma City, Oklahoma
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